Medicare Advantage – FOLLOW-UP

November 15, 2023

The recent communication about Medicare Advantage led to several questions. Please see answers below:

Will Medicare Advantage reimburse traditional Medicare paneled LCSWs?  Since Medicare Advantage is a separate program from traditional Medicare, it does not reimburse claims for traditional Medicare.

Why does Medicare Advantage often pay less than traditional Medicare?  Because Medicare Advantage plans are run by commercial insurers, some reimburse at less than traditional Medicare and some at a higher rate. Remember that traditional Medicare rates vary from region to region as well.

Should LCSWs accept Medicare Advantage, even if rates are lower, because it is all that some people can afford?  Some people think of Medicare Advantage as a midway point between Medicare and Medicaid and want to accept these plans to offer services to lower income patients.

How can we make Medicare Advantage have reimbursement parity with traditional Medicare?  Medicare Advantage is a completely different system from traditional Medicare with different reimbursement. Medicare Advantage reimbursement has reimbursement governed by commercial insurers; traditional Medicare has reimbursement governed by CMS. While CSWA has advocated for reimbursement parity in traditional Medicare (with medical/surgical reimbursement) and in commercial plans (with medical/surgical), there is no way to create parity between Medicare Advantage and traditional Medicare.

How can we improve access to mental health treatment in general? There is no one way to accomplish this but the new mental health parity rules and integration of primary care and mental health should help.

Do LCSWs have to be credentialed with Medicare to be eligible for Medicare Advantage?  No. The reverse is true as well, i.e., LCSWs can be credentialed with Medicare without accepting Medicare Advantage patients.

Do LCSWs have to be credentialed with the commercial insurer sponsoring the Medicare Advantage plan?  This varies, but in general it is not necessary to be credentialed with a commercial insurer to be reimbursed for a Medicare Advantage plan. Check with each plan.

How much will Medicare Advantage plans affect Medicare beneficiaries going forward?  Many analysts have said that the Medicare Advantage plans will continue to grow to cover 50-60% of Medicare beneficiaries by 2030.

Please continue to send questions on Medicare Advantage as they occur.

Laura Groshong, LICSW, Director, Policy and Practice  
lwgroshong@clinicalsocialworkassociation.org